This past week in healthcare investigations

Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.

India's Pain Tx Boom

Opioid drugmakers are eyeing an enormous new market: India.

According to a Kaiser Health Newstwo-part series, pain management is a booming industry in the country, spurred by relaxed narcotic regulations resulting from palliative care advocacy.

As more pain clinics pop up, American companies under scrutiny for their role in the U.S. opioid epidemic are meeting the demand. There are fentanyl patches from a Johnson & Johnson subsidiary; buprenorphine from Mundipharma, controlled by Purdue Pharma's Sackler family; and tramadol from Abbott.

One of the biggest changes was a 2014 amendment to the country's Narcotic Drugs and Psychotropic Substances Act that made pain relief an "important obligation of the government" and established a list of essential opioid narcotics including morphine, fentanyl, oxycodone, hydrocodone, methadone, and others.

The story also profiles pain management physicians who are leading the charge, such as G.P. Dureja, who runs a pain clinic in east Delhi. Dureja charges $10 for a consultation, $10 for a Johnson & Johnson fentanyl patch, and $10 for a Mundipharma buprenorphine patch -- and takes a 15% cut of sales.

With the increase in pain treatment, warning signs of addiction abound: government surveys revealed addiction to prescription opioids is on the rise, and buprenorphine, an addiction treatment, is itself being abused, KHN reported.

VA Knew About Problem Pathologist

The pathologist who misdiagnosed some 3,000 cases at an Arkansas VA hospital had a history of problems that the agency swept under the rug for a long time, the Washington Post reports.

When the Fayetteville VA hired Robert Morris Levy in 2005, he had a sterling resumé: an Air Force veteran with a medical degree from the University of Chicago, a pathology residency at the University of California San Francisco, and a hematology fellowship at Duke University.

But he also had a small tarnish on his record: a 1996 conviction for drunk driving in California that carried three days in jail and three years' probation. The VA wouldn't say whether it knew about the incident before Levy was hired.

One of the first documented problems with Levy's performance came in March 2016 when he was called to the radiology lab to help with a biopsy and showed up drunk. His blood alcohol level was 0.4, a number that usually carries a risk of coma or death.

VA officials suspended Levy and reported his alcohol impairment to state medical boards. After 3 months of inpatient rehab in Mississippi, he returned to the pathology lab under the condition of random drug and alcohol tests.

In October 2017, he showed up to a meeting drowsy and incoherent, but tested negative for drugs and alcohol. The VA suspended his clinical privileges but allowed him to return to non-clinical work.

Then in March 2018, he was arrested for drunk driving, and the VA fired him the next month when toxicology reports showed a drug called 2M2B in his blood. The compound induces an alcohol-like buzz but isn't detected on standard drug tests.

An 18-month review of Levy's pathology reports was just completed this summer. He was charged in August with three counts of involuntary manslaughter in the deaths of three veterans. VA officials now acknowledge that he misdiagnosed at least 15 patients who later died, and 15 others whose health was seriously harmed. Officials say the botched diagnoses began the year he was hired.

Levy is now in jail in Fayetteville.

Mysterious VA Deaths

Senators are pressing the Trump administration to move fast on its investigation into 10 suspicious deaths -- including two homicides -- at a VA hospital in West Virginia, reports USA Today.

Senate VA Committee Chair Johnny Isakson (R-Ga.) and ranking member Sen. Jon Tester (D-Mont.) spoke with VA Secretary Robert Wilkie last week about the latest developments in an ongoing probe by the department's Office of Inspector General (OIG).

USA Today reported last week that at least two deaths that occurred at the center last year were ruled as homicides. The cause of death for both veterans, George Nelson Shaw Sr. and Felix Kirk McDermott, changed after their bodies were exhumed and a medical examiner found they both died from insulin injections, though neither had a history of diabetes.

Authorities are said to be investigating an unnamed person of interest who no longer works at the Louis A. Johnson VA Medical Center in Clarksburg, West Virginia.

Hospital officials there first alerted the OIG about the suspicious deaths in June 2018. The FBI is also investigating.

Sacklers Stash Cash Offshore

As litigation bears down on the Sackler family, its finances are proving to be enormously complicated and possibly structured to hide assets, the Associated Press reported.

For instance, the family's English countryside estate is run by a Bermuda company, though some of the land is owned by five more companies, three of which are also in Bermuda. The main company is owned by yet another offshore company, and all of these are controlled by a trust based in Jersey in the Channel Islands, according to the AP.

Bermuda also happens to be the base for Mundipharma, the Sacklers' network of companies set up to do business beyond North America. It also is home to other family foundations, real estate holding companies, and an insurer.

Some states allege the network has made it easy for the family to move money out of Purdue to insulate their fortune.

The complexity could pose a challenge for lawyers trying to size up the family's finances in preparation for settlement talks. New York has issued subpoenas to 33 Sackler companies, advisers, and banks in order to get more details about money transferred out of Purdue.

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